What a day
When I spoke with the nurse Monday night she said they were going to switch Porter off the Drager vent and onto an older model. I asked her why and she said the older model has a sensitivity setting that will compensate for the leak from his trach and the vent won't alarm as much. I informed her that they had him on the vent she was talking about when he first arrived on May 23rd but he was not oxygenating well on it and asked that they keep him on the Drager despite the annoying alarm. She said she would bring it up to the doctors.
Well, when I arrived this morning low and behold Porter was not on the Drager but the other vent and was REALLY retracting as he breathed. I immediately asked our nurse to find the doctor and requested he be put back on the Drager. The nurse called the doctor and the doctor said......... Put that kid back on the Drager. RT came and switched the vents out and he started breathing a little better but not much. Porter then looked at me with almost a fearful look and gave out a huge cry, not just a simple whimper around his trach but a full on loud lung filled cry. Well that told me immediately something was not quite right. I asked the RT to check his trach to make sure it was actually in and it wasn't. It was hanging out with just the inflated cuff at the bottom holding his stoma (hole) open. It had probably been like this for a good half hour. The good thing is Porter didn't desat and remain well oxygenated which to us says his lungs are doing pretty well. Once the Trach was placed back in, Porter settled and took a good nap. He took several cat naps throughout the day.
Around 3:00 his heart rate started creeping up and up and up into the 190's which is sooo dangerous for lil P. They started an iv infusion of Esmolol to try to bring his rate down which after about 20 minutes stated working. He was supposed to start his new heart med Sotalol on Wed but the doctor consulted the Electro physiologists and they wanted them to start him early. Porter received his first dose of Sotalol around 6pm and so far his heart rate has been in the 130's. He's been sleeping well this afternoon probably from being exhausted from the day and the adivan they gabve him.
Wound care came by an looked at his gtube area. Steve and I brought up out concern of how the site looked over a week ago and when Porter was transferred to the ICU yesterday our nurse thought it looked a little yucky so they changed the dressing and called for wound care consult as the site looked a little red and seepy. Wound care said the dressing should be changed every 7 days and the site cleaned twice per day- none of which was happening. The nurse for wound care cleaned the site and they put the order in the computer to make sure it happens.
Porter has been tolerating his jet fuel and did gain a little more over night.